Healthcare Provider Details

I. General information

NPI: 1285892851
Provider Name (Legal Business Name): LARRY JAMIESON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 COUNTY ROAD 340
CHERRY VALLEY AR
72324-8943
US

IV. Provider business mailing address

113 COUNTY ROAD 340
CHERRY VALLEY AR
72324-8943
US

V. Phone/Fax

Practice location:
  • Phone: 870-588-3765
  • Fax:
Mailing address:
  • Phone: 870-588-3765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: